Risks of adverse respiratory outcomes in adults with cancer over the course of survivorship compared with cancer-free individuals: a matched cohort study using linked English electronic health records

Figures

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  Fig. 1. Adjusted relative risks (Hazard ratios [HR] and 95% confidence intervals [CIs]) stratified by time of experiencing new-onset chronic respiratory diseases after cancer diagnosis in survivors of 20 cancers compared with cancer-free comparators. Adjusted Hazard Ratio: adjHR; CI: Confidence interval; COPD: chronic obstructive pulmonary disease; CNS: central nervous system ILD: interstitial lung disease, M.Melanoma: Malignant melanoma; NHL: non-Hodgkin’s lymphoma. Forest plots show adjusted HRs (95% CIs) overall and stratified by time since diagnosis; numeric labels indicate overall adjusted HRs only. Models are minimally adjusted for age, gender, and GP practice by matched design and additionally include deprivation (IMD), body mass index (BMI) categories, smoking status, history of chronic respiratory disease (excluding the outcome of interest), chronic kidney disease, hypertension, cardiovascular disease, diabetes, chronic liver disease, and multiple sclerosis. Reference line HR = 1.0 indicates no association, with higher relative risks in cancer survivors >1. Y axis: Cancer types with associated ICD-10 codes. See Supplementary Table A22 for all HRs and 95% CIs.

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  Fig. 2. Adjusted absolute rate difference and crude incidence rates (IR) per 1000 person-years of new-onset chronic respiratory conditions in cancer survivors and matched cancer-free individuals by cancer site. COPD: chronic obstructive pulmonary disease; CNS: central nervous system ILD: interstitial lung disease, M.Melanoma: Malignant melanoma; NHL: non-Hodgkin’s lymphoma. Crude IRs per 1000 person-years are shown in brackets [survivors/cancer-free individuals]. Adjusted rate differences were estimated as IRe − (IRe × 1/HRadj), where IRe is the incidence rate per 1000 person-years in cancer survivors and HRadj is the adjusted hazard ratio for each time stratum. Estimates were averaged across time strata to provide a summary rate difference for each cancer-outcome pair. ∗Overall adjusted HRs were used where time-stratified estimates were unavailable due to insufficient power. ˆAdjusted HRs could not be calculated.

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  Fig. 3. Adjusted relative risks (Hazard ratios [HR] and 95% confidence intervals [CIs]) stratified by time of experiencing exacerbations after cancer diagnosis in survivors of 20 cancers compared with cancer-free comparators, among those with a pre-existing diagnosis. Adjusted Hazard Ratio: adjHR; CI: confidence interval; COPD: chronic obstructive pulmonary disease; CNS: central nervous system ILD: interstitial lung disease, M.Melanoma: Malignant melanoma; NHL: non-Hodgkin’s lymphoma. Models are minimally adjusted for age, gender, and GP practice by matched design and additionally include age (time-updated if respiratory condition diagnosed during follow-up), gender, region, deprivation (IMD), body mass index (BMI), smoking status, history of chronic respiratory disease (excluding the outcome of interest), chronic kidney disease, hypertension, cardiovascular disease, diabetes, chronic liver disease, and multiple sclerosis. Reference line HR = 1.0 indicates no association, with higher relative risks in cancer survivors >1. Y axis: Cancer types with associated ICD-10 codes. The number of events in each group and adjusted HR by cancer site are also displayed. Some models failed to converge…

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  Fig. 4. Mean cumulative count of exacerbations over time by survivorship status and cancer site for lung cancer, multiple myeloma, leukaemia and non-Hodgkins’ lymphoma (NHL). COPD: chronic obstructive pulmonary disease ILD: interstitial lung disease; NHL: non-Hodgkin’s lymphoma. Cancer survivors (yellow) and matched controls (purple). The y-axis shows the mean number of exacerbations, while the x-axis represents time in years since the index date and the number of individuals at risk in cancer survivors and below, of those without a history of cancer, at each timepoint.